HomeMy WebLinkAboutXR2023-2612 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm] F" Residential City of Newport Beach -Building Division
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F-Building F_ Grading F-Drainage F-Elec F-Mech F Plum CuvdCut s cuvdFili s
Project Address (Not mailing address) F- Flood F- Fire F Liq r Landslide F-N/A Floor Suite No
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Description of Work
Use Const Type
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# Stories # Units (if Res)s
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Valuation $ F6v(,�;c
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Material/Labor
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
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City 6'P5 State C� _AT_
Zip 617,&& '� Telephone[ —
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APPLICANT'S NAME Last �I &N
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Applicant's Address Applicant's E-mail Address
City A j7•, State Cf /J� — Zip p /'1 Telephone �Y'�
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ARCHITECT/DE/SIGNER'S NAME
Last First �— Lie. �—
No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City State r Zip F_ Telephones —
ENGINEER'S NAME Last f_y/ tj Z J! First Oss— Lic. No. L 30N 0
Engineer's Address Engineer's E-mail Address
City SW.4& State L) - Zip C('Z_-'�-J' Telephone G
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CONTRACTOR'S NAME/COMPANY �Yt,irCt� f, / _. sCCp,L Lic. No. Class
77
Contractor's Address Contractor's E-mail Address
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City 0773 State I[,/ -I- Zip F9Z(o60 Telephone �Y����
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S